Clinical Translation of Memory Reconsolidation Research:

Bruce Ecker

Abstract

After 20 years of laboratory study of memory reconsolidation, the translation of research findings into clinical application has recently been the topic of a rapidly growing number of review articles. The present article identifies previously unrecognized possibilities for effective clinical translation by examining research findings from the experience-oriented viewpoint of the clinician. It is well established that destabilization of a target learning and its erasure (robust functional disappearance) by behavioral updating are experience-driven processes. By interpreting the research in terms of internal experiences required by the brain, rather than in terms of external laboratory procedures, a clinical methodology of updating and erasure unambiguously emerges, with promising properties: It is applicable for any symptom generated by emotional learning and memory, it is readily adapted to the unique target material of each therapy client, and it has extensive corroboration in existing clinical literature, including cessation of a wide range of symptoms and verification of erasure using the same markers relied upon by laboratory researchers. Two case vignettes illustrate clinical implementation and show erasure of lifelong, complex, intense emotional learnings and full, lasting cessation of major long-term symptoms. The experience-oriented framework also provides a new interpretation of the laboratory erasure procedure known as post-retrieval extinction, indicating limited clinical applicability and explaining for the first time why, even with reversal of the protocol (post-extinction retrieval), reconsolidation and erasure still occur. Also discussed are significant ramifications for the clinical field’s “corrective experiences” paradigm, for psychotherapy integration, and for establishing that specific factors can produce extreme therapeutic effectiveness.

1. Introduction A primary dilemma in clinical psychology has been described by one of that field’s leading voices in this way: “After decades of psychotherapy research, we cannot provide an evidence-based explanation for how or why even our most well studied interventions produce change, that is, the mechanism(s) through which treatments operate” (Kazdin, 2007, p. 1). The present article proposes that a fundamental breakthrough in that dilemma may be developing through the translation of memory reconsolidation neuroscience into clinical application.

Memory research has identified an innate type of neuroplasticity in the brain, known as memory reconsolidation, that can destabilize the neural encoding of learnings of many types, including emotional learnings. Destabilization in turn allows the target learning to be nullified either endogenously, by behavioral counter-learning, or exogenously, by pharmacological blockade that disrupts the natural molecular and cellular process of restabilization, or reconsolidation, that normally would occur after several hours (Duvarci and Nader, 2004; Pedreira et al., 2002; Pedreira and Maldonado, 2003; Walker et al., 2003). Thus nullified, the subsequent durable, robust disappearance of all expressions of the target learning has been termed its erasure by many researchers (e.g., Kindt et al., 2009; for reviews see, e.g., Agren, 2014; Nader, 2015; Reichelt and Lee, 2013; Schwabe et al., 2014; for a review of early, anomalous observations of erasure prior to discovery of reconsolidation, see Riccio et al., 2006). By putting the transformational change of memory on empirical solid ground, research on memory reconsolidation has paved the way for new common ground between neuroscientists and clinicians, who have filed fine-grained anecdotal reports of such transformational change for decades (e.g., Ecker and Hulley, 1996, 2000a, 2008; Fosha, 2000; Greenberg et al., 1993; Shapiro, 2001).

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Memory reconsolidation is a neurological process that is experience-driven: behavioral and perceptual events trigger it into occurring and can govern the resulting effects on the target learning. The relevance of reconsolidation research findings to psychotherapy is potentially very great because clinical symptoms are maintained by emotional learnings held in implicit memory, outside of conscious, explicit awareness, in a wide range of cases, including most instances of insecure attachment, post-traumatic symptomology, compulsive behavior, addiction, depression, anxiety, low self-esteem, and perfectionism, among many other symptoms (e.g., Greenberg 2012; Schore, 2003; Toomey and Ecker, 2007; Van der Kolk, 1994). A versatile, reconsolidation-based clinical methodology that targets and reliably nullifies the specific emotional learnings maintaining such symptoms would revolutionize the field of psychotherapy. Envisioning that new landscape, neuroscientists Clem and Schiller (2016, p. 340) wrote, “To achieve greatest efficacy, therapies…should preclude the re-emergence of emotional responses.” Defining complete elimination of unwanted emotional responses as the goal of psychotherapy is a statement that no neuroscientist would have ventured to make prior to 2000, before the discovery of memory reconsolidation. It is a goal now recognized as a possibility grounded in empirical research. That goal is the operational definition of erasure in this article: lasting, effortless, complete cessation, under all circumstances, of an unwanted behavior, state of mind, and/or somatic disturbance that had occurred either continuously or in response to certain contexts or cues.

Currently, at the end of the second decade of laboratory research into reconsolidation, researchers’ attention is extending to considerations of clinical translation at a rapidly accelerating pace (e.g., Beckers and Kindt, 2017; Dunbar and Taylor, 2016; Elsey and Kindt, 2017a; Krawczyk et al., 2017; Kroes et al., 2015; Lee et al., 2017; Nader et al., 2014; Treanor et al., 2017). Those authors have consistently called for a two-way flow of knowledge between researchers and clinicians in order to achieve the fullest clinical utilization of memory reconsolidation. Nader et al. (2014, p. 475) wrote:

We feel that ongoing discourse between mental health clinicians and neuroscientists is beneficial both for scientific progress in neuroscience and mental health treatments. Neuroscientists may benefit from being educated about clinical models of mental disorders…. The reductionist approach intrinsic to scientific activity forces neuroscientists to simplify their models in the pursuit of scientific questions considered to be of a fundamental nature. Unavoidably, at times, this approach may ignore some aspects of mental disorders. A discourse with clinicians allows neuroscientists to realign their models to ensure that they represent processes thought to cause or maintain these disorders.

Similarly, researchers Elsey and Kindt (2017a) opined that “Dialogue between researchers and clinicians must be maintained” (p. 114) and, in concluding an extensive review of the prospects for effective clinical application of reconsolidation research findings, commented, “there are significant limitations to experimental research, and ultimately only attempts at treatment can reveal the utility of a reconsolidation-based approach” (p. 115).

Those comments serve to define the purpose of the present article, which is a report from the clinical trenches of observations made in the course of directly applying the empirically identified, endogenous process of memory erasure. This article describes what appear to be encouraging advances. The author, a psychotherapist and former research physicist, has since 2005 maintained close scrutiny of reconsolidation research while also closely observing the effects in therapy sessions of processes designed to translate memory reconsolidation research into clinical application.

Members of the clinical domain have been enthusiastically consuming and working to utilize the knowledge being generated by laboratory neuroscience researchers since the 1990s (e.g., Siegel, 1999; van der Kolk, 1994). There has been little to indicate a flow of knowledge in the other direction, however. Undoubtedly there is more than one reason for that asymmetry, which is particularly acute at present as regards reconsolidation. There is now a substantial clinical literature that documents observations ascribed to reconsolidation and that delineates clinical methodologies demonstrating translation of reconsolidation research (e.g., Ecker, 2008, 2010, 2015a,b, 2016; Ecker and Hulley, 2008, 2017; Ecker and Toomey, 2008; Ecker et al., 2012, 2013a,b; Högberg et al., 2011; Lasser and Greenwald, 2015; Sibson and Ticic, 2014; Soeter and Kindt, 2015a; Ticic and Kushner, 2015). Rarely, however, is such literature cited in the writings of laboratory researchers, who regularly express anticipation of and need for advances already made by clinicians. Examples of that are myriad; the two most recent instances encountered by the author are these: Krawczyk et al. (2017, p. 16) commented that “outside the laboratory settings such as in clinical ones, it is unclear how the reconsolidation process might work.” Elsey and Kindt (2017a, p. 114) commented that laboratory research has focused largely on fear learnings and that “experiences of other emotions, such as disgust…or of more complex feelings such as guilt and shame after reconsolidation-based procedures are essentially untapped.” In fact, numerous clinicians’ reports have documented in a fine-grained manner how a wide range of complex emotions and emotional learnings have been subjected to the empirically confirmed reconsolidation process of behavioral erasure (see citations above in this paragraph; for online listings of relevant clinical reports, see http://bit.ly/2tKXdyX and http://bit.ly/15Z00HQ). Section 7 of this article provides samples of such clinical work and its documentation.

The rigor of the clinical observations reported here is of a different type from that of the quantitative measurements made in laboratory controlled studies by neuroscientists. Here the aim is phenomenological rigor that capitalizes on the unique ability of human subjects (therapy clients) to direct attention to their own mental and emotional states and to describe the moment-to-moment effects as the steps of the destabilization and erasure process are carried out. Neuroscientists have barely begun to utilize such articulation of subjective experience for gaining access to the memory reconsolidation process, but even their first forays in that direction were very fruitful (Sevenster et al., 2013, 2014). The clinical case studies documented in this article are intended to show that examining the raw data of therapy clients’ real-time phenomenological reports can significantly help advance the clinical translation of memory reconsolidation research (see also Heatherington et al., 2012).

The clinical work reported here is intended to demonstrate the application of reconsolidation research, so an examination of relevant research and its translational implications precedes the clinical material detailed in Section 7. As noted, reconsolidation has been demonstrated and studied for many different types of memory, but the research covered here is limited to how the process applies to emotional learning and emotional memory, as they play by far the principal role in psychotherapy. (See reviews cited above for the full range of research.) The cellular and molecular levels of reconsolidation research are also not covered here. Clinicians need not attend to the highly complex neurophysiological and neurochemical substrates of destabilization and erasure (for a review of which, see Clem and Schiller, 2016). However, clinicians should understand that robust functional erasure does not necessarily correspond to total loss or ablation of the entire neural encoding of the erased responses and learnings, according to recent findings (Ryan et al., 2015), and any simplistic image of what happens to neural circuits when erasure is achieved is almost certain to be significantly incorrect.

Lastly, regarding this article’s usage of an emotional “learning”: A terminology bridge between neuroscientists and clinicians is much needed. Memory researchers as a rule refer to a learned item of any type as a “memory,” not as a “learning”; they refer to the “target memory” rather than the “target learning.” If the learned item in question is, for example, implicit knowledge that would be verbalized as “If I express myself I’ll be criticized and rejected,” researchers would refer to that as the “memory” under study. That usage of “memory,” while perfectly clear to memory researchers, is likely (in the author’s experience) to create considerable confusion for clinicians, who would tend to understand “memory” as referring to the person’s episodic memory and/or declarative memory of the original childhood events involving rejection, rather than the semantic memory consisting of a generalized model and expectation of people being active rejecters. In order to avoid that confusion for clinician readers (this article being intended for both memory researchers and clinicians), the text here refers to an “emotional learning.” That syntax is identical to how “understanding” may be used as in “it resulted in the understanding that….”

The Yoga Banyan Tree

(article 1 of 3)

Dr Vijoleta Braach-Maksvytis

Founder, Senses and Stillness Science Innovations in Yoga

This first article traces some of the lesser known roots and branches of Yoga and how they weave into modern neuroscience and psychology, melding with integration science. The second article will review in more detail the research evidence for the broad-ranging benefits of Yoga to the body, mind, and spirit, gathered from diverse fields such as epigenetics, immunology, clinical psychotherapy, cardiovascular disease, multiple sclerosis research, aging, and mental health. The third paper will outline the framework the author has developed for Yoga as applied to neuroscience, illustrating with case studies drawn from her clients, students, and postgraduate yoga teacher trainees.

Yoga is the art of navigating our internal world. Yoga’s insightful sophistication in choice of tools to navigate the mind’s devastating or blissful effects on well-being draws on the interrelationships between the heart, body, wisdom, spirituality, and the universe.

This inner world of Yoga complements the neurosciences. In neuroscience the focus is the brain as a living organism with behavioral consequences. The field is fundamentally changing and enhancing our understanding and treatment of mental and physical disorders.

By contrast, the inner personal world is a mystery. With cultural emphasis and preoccupation with the outer material world, does anyone really know the internal world of their own self? How is it that we

have learnt to stop the flow of mighty rivers but do not know how to lessen the flow of our own thoughts? We have built an enormous knowledge base that has allowed us to locate the furthest galaxies, yet we cannot find our own quiet center or the door to lead us out of the darkness of depression. We do not know how to be still or how to manage our thoughts so that they do not intrude into our sleep, our relationships, our feelings, and our language. We manage our fear, anxiety, depression, and anger by suppression, or staying busy, or by denial. We are afraid of silence and stillness. We fill every moment of our time with streams of activities, keeping the mind continuously busy. Even what we call relaxation or leisure time involves activity of a mind kept busy.

It is into this chaos of the inner mind that the technologies of Yoga[1] can enter and hold their own. More than a somatic therapy, Yoga is a more than 4000-year-old experiential science of integration, a practical philosophy (darshana), a technology with a vast range of psychospiritual techniques, the aim of which is the integration and union of the self with the higher self, whatever that personally means to an individual. The key is gaining control of the mind in amongst the chaos and debris of thoughts, experiences, memories, and sensations, to connect to and re-merge with the light of one’s original source, the ever-present higher self.

Recognizing that no two people are alike, Yoga has evolved a myriad of tools and multiple entry points for this integration process to suit the full range of individual temperaments. Ultimately, everyone has their own path, and in Yoga there is no one “correct” path to suit everyone.

There is a steady growth both in the uptake of Yoga as a practice and of research into Yoga, with more and more people turning to these ancient practices for physical, mental, and spiritual well-being. Findings from research on modern postural yoga (the most familiar and simplified practice of Yoga) support the fundamental premise of ancient Yoga wisdom discovered through experiential knowledge—that Yoga impacts the whole person.

The Rise of Science Research into Yoga

Spanning more than four millennia, Yoga has been a fundamental component of Indian life, thought, study, research, and spirituality. By contrast, in the west, Yoga and meditation have only started to gain attention in recent decades, with rapid growth in research at universities and centers, programs in hospitals and care facilities, and collaboration with India. The last 10 years in particular have seen an exponential rise in the number of peer-reviewed publications on Yoga, spanning the fields of science, medicine, psychology, psychiatry, interdisciplinary studies, and other non-science fields.[2]

It was in the early 1960s that reports of studies on Indian “yogis” filtered into the west through science journal publications reporting measurements of extraordinary physical and mental feats (Wenger, Bagchi, & Anand, 1961). Trained at Yale in 1950, B. K. Anand, considered the founder of modern neurophysiology in India and specializing in the hypothalamic system, included in his research some investigations into the ability of yogis to voluntarily induce changes in heart rate and pulse, breath control, and electrical activity in the brain. (For a review of these studies published between 1961 and 1968, and of his wider 50 years of science contributions, see Mallick, 2001). This caught the interest of the western scientific community as new studies were just beginning to indicate that it might be possible to exhibit voluntary control over some aspects of the autonomic system, previously thought to be under involuntary control (Schwartz, Shapiro, & Tursky, 1971).

Active scientific interest in yoga and meditation continued during the next decade (Shapiro, 1985) and expanded into Buddhist techniques, and it was one of the latter that Harvard University’s cardiologist Herbert Benson and colleagues studied, measuring the stress-reduction effects of meditation (Beary & Benson, 1974). Credited with bringing spirituality and healing to western medicine,[3] Benson changed the ancient terminology of “meditation” into what he called “the scientific name for meditation”, coining the term relaxation response, as well as helping to popularize the term “mindfulness” (Benson, Greenwood, & Klemchuk, 1975; Benson & Klipper, 1975/2001), which is now used in a wide range of therapeutic settings, usually divorced from its origins within the much broader spiritual practices of Yoga originating in India and Tibet. The Benson-Henry Institute for Mind–Body Medicine at Massachusetts General Hospital was established in 2006, and subsequently Harvard University set up six more centers: a functional neuroimaging laboratory; cognitive, affective, and contemplative neurosciences; the Lazar Lab; the neuroscience of meditation, healing and sense of touch; the Osher Center for Integrative Medicine; the Khalsa Lab on Yoga Research; and Ellen Langer’s Lab. These and other centers around the world are driving the critical mass needed for the expansion of research in this field.

A survey of the results from research into Yoga highlights a number of consistent trends, outlined below:

Due to the involvement of all the dimensions of the person (the mind, breath, and spirituality as well as the body), a greater reduction in the stress response is observed for yoga compared to gym exercise (Govindaraj, Karmani, Varambally, & Gangadhar, 2016; Sengupta, 2012).

Stress reduction is not just limited to slowing the heart rate and breath, but induces changes on all levels, including expression of chronic stress-related genes (Buric, Farias, Jong, Mee, & Brazil, 2017).

Yoga changes brain structure and function; for example, enhanced executive function has been identified in older yoga practitioners compared with a control group who only did stretches and strengthening exercises (Gothe, Kramer, & McAuley, 2014).

Eight to 16 weeks of yoga is sufficient to facilitate these remarkable changes in the brain and body.

Most of the published research is based on participants attending a general yoga class. Specialised yoga classes for specific conditions in most cases are not needed to gain improvements.

The Stress Response and Yoga

Awareness of stress is growing worldwide, but the recognition that stress can have a detrimental effect on health is not new. There have been publications during at least the last 40 years connecting stress to health. In the 1970s, stress was known to have a major role in cardiovascular disease, cancer, arthritis, and respiratory disease (Pelletier, 1977), and in the 1980s it was estimated that between 50% and 80% of visits to the doctor stemmed from stress-related conditions (Cummings & VandenBos, 1981; Shapiro, 1985). In this decade, specific forms of stress with acute health consequences are rising: an analysis of the World Health Organization Global Burden of Disease Study 2013 (Whiteford, 2015) estimated that mental, neurological, and substance use disorders were the leading cause of years lived with disability worldwide; see also Whiteford et al. (2013). Stress intrudes into almost every aspect of our health, affecting the immune system and contributing to gastrointestinal disorders, excessive weight disorders, mental health disorders (including depression, anxiety, schizophrenia, autism, trauma), autoimmune disorders, insomnia, cardiovascular disease, cancer, chronic pain, ageing, dementia, Alzheimer’s disease, asthma, fibromyalgia, and the list goes on.

Reducing the stress response, even for a short time, can relieve some of the detrimental effects of stress involving changes at the level of the brain structure itself—such as shrinking the hippocampus (memory impairments), increasing the size of the amygdala (raising levels of fear and anxiety), and decreasing blood flow to the prefrontal cortex (executive function impairment). These effects extend into the body, affecting every aspect of health. Chronically elevated sympathetic nervous system (SNS) responses trigger the hypothalamus–pituitary–adrenaline (HPA) axis and the subsequent circulation of chemicals, hormones, and neurotransmitters like cortisol and adrenaline throughout the body. A focus on reducing stress consequently results in a cascade of benefits on numerous physical and mental health disorders, even when these are not specifically targeted.

My aim in Yoga is to give my students and clients a rest from their ever-active mind and elevated SNS. They call it a feel-good experience. I know their minds and nervous systems have indeed had some time out because of the visible effects in their faces and bodies. Allowing the parasympathetic nervous system (PNS) to activate a little more to balance out the autonomic nervous system is reinforced with dopamine release. When that feel-good dose is repeated weekly, or preferably two or three times a week, new physical patterns begin to surface over time, with corresponding changes in their mental habits. Regular yoga experiences extend these changes into their daily lives.

The Mind

In Samkhya philosophy, the mind has three principle aspects: buddhi, the higher wisdom; ahamkara or ego, the “I” that separates us from our source; and manas, coordinating senses, action, emotion, sensation, and imagination. A primary cause of spiritual, physical, and mental disorders is the inability to hold on to the buddhi, leading to poor judgement, wrong values, and false beliefs.

In Tantra there are additional levels. These are the ability to create, maintain, and dissolve our thoughts and actions. Between the dissolution stage and the creation of the next thought there is the opportunity for grace or concealment, but most of us move from thought to thought without pause; grace eludes us, and we continue in a thought loop. Without adding regular pauses and stillness into our lives, grace will continue to elude us, being replaced by a false sense of separation, the concealment of what is always present within us. In Balinese Yoga, there is no separation between the heart and the mind.

The way the mind accumulates experiences and shapes our behavior is via samskaras, akin to behavioral imprints in psychology. Samskaras are formed in the following way:

Every moment presents choices for us. Each of these choices results in an experience that might leave an impression.

Cascading changes throughout the body affect the function of heart and gut, and vice-versa. This shifts the breath and changes gene expression.

Experiences become consolidated into different layers in our memories. Procedural memory (our “auto-pilot”) is modified by our experiences and is expressed in our automatic responses and in our bodies. Therefore, the choices we make will shape who we are and who we will become.

These experiences influence our next choices, and when repeated, begin to create patterns of choices.

Unless cleared in some way, our impressions from these experiences—samskaras—accumulate over a lifetime and build habits and behaviors that are now below conscious control.

If we stay trapped in thoughts and emotions of anger, resentment or frustration, then in Yoga terms we will attract similar prana (or energies) like a magnet and increase our sense of isolation and separation from our higher self, which is the ego part of the mind.

In neuroscience terms, we make neural connections that reinforce the pathways to these thoughts and responses, and hence they become the first go-to response pattern when stimulated. These neural patterns are formed via Hebb’s axiom—neurons that fire together, wire together (Hebb, 1949)—and have a physiological and chemical effect on our breath, pulse rate, blood pressure, gut microbiome, muscular tension, sensitivity to pain, and immune response and extend into every aspect of our physical and mental health.

Lastly, our mind becomes more prone to fear and anxiety, the loop continues, and our body and brain are re-shaped.

There are a number of Yoga techniques that can act as an antidote to this process and clean out an onion-like layer of accumulated samskaras and karmic debris. The most accessible of these include stillness practices, meditation, authentic actions carried out with no attachment to the results, devotion to a symbol of your higher self, and breath.

There are, in addition, a range of techniques in Yoga that are specifically for changing memories. Because our mind is constantly creating thoughts, processing sensory and motor input, drawing on memories and the emotions, it is in constant flux. Those aspects of ourselves that change are therefore unreliable (because they might change again), and we can lose sight of our stable discerning center, the unchanging witness state. These techniques are based on recalling a memory or thought and then dissolving it in various ways. This process is somewhat similar to memory reconsolidation, which requires reactivation of a memory to place it into a labile state in order to make it open to change or deletion. Hence, just like in Yoga, memory systems are thought to be flexible, adapting to our behaviors and acting out at the level of cognition, and likely to have a metaplastic nature (Nader, Hardt, Einarsson, & Finnie, 2013).

What Is Yoga?

Yoga is a multifaceted intervention. It is a self-regulated pharmacy practice, with the ability to shift the biochemical make-up, neurotransmitter balance, microbes, electric fields, and more. It also uses movement, stillness, imagery, mind, breath, and intention to produce specific kinesthetic and emotional states, as well as physical changes.

Yoga has a vast history spanning at least four millennia, and a much older oral tradition. It is not easy to define as its original roots have extended much further and more widely than is popularly perceived. Like the banyan tree (Figure 1), Yoga’s “trunk” is one of India’s six major ancient darshanas (a darshana is a philosophy, or rather a particular “view”) that has developed multiple shoots and roots that have entwined and interpenetrated with others.These have evolved over the centuries through the accumulation of embodied experiential evidence and the application of scientific rigor in the methodology of enquiry. There are connections with the Vedas, the ancient Sanskrit texts that date from the very beginning of Indian culture. Yoga is the inner science, the experiential knowledge of the highest level of interconnectivity between humans, the universe, and the all-pervading consciousness, with multiple paths, techniques, and technologies.

Yoga is mentioned throughout the evolution of Indian philosophy, including Buddhism and Jainism, and other branches that originated around 500 BCE. The early centuries of the Common Era saw the emergence of the dualist philosophy of Samkhya, another of the six darshanas. A follower of the Samkhya, Pataňjali, compiled the Yoga Sutras within the Yoga Darshana before 400 CE. At the turn of the first millennium of the Common Era, the non-dualist philosophies of Vedanta and the cross-pollination between Shaivism and Buddhism emerged. By the 8th century Vedanta was refined, and four paths of Yoga were outlined: Karma Yoga (action), Jnana Yoga (knowledge), Bhakti Yoga (love and devotion), and Raja Yoga (involving meditation).

The period 300–1300 CE saw the emergence from Shaivism/Buddhism of Tantra spirituality, bringing in the feminine principle, Shakti: “If there is only the one Self, why should there be such a struggle involved in realizing it? In other words, why do we have to think of the world, and thus the mind–body, as an enemy that has to be overcome?” (Feuerstein, 2008, p. 341). Union with the higher self can be realized through the body and even within all things manifest, because everything is Shiva/Shakti. The co-development of Tantra in both Indian Darshana and Buddhist schools resulted in a strong overlap between the two, particularly Vajrayana and Mahayana Buddhism. Tantra was flourishing in India by the 8th century, and Buddhist Tantra expanded into Tibet, China and South–East Asia, including Indonesia. The Hindu–Buddhist fusion still exists today in Bali.

Tantra gave rise to Hatha Yoga around 1400–1600 CE, with a possible merging of Hatha and Raja Yogas. The Yoga practices reported by British colonials highlighted the more spectacular aspects of the minor branch of “left-handed” Hatha yogis, whose practices included the breaking of societal taboos to challenge their spiritual strength. Vivekananda is credited with bringing Yoga to the attention of the west when he represented India at the first Parliament of the World’s Religions, held in Chicago, IL, in 1893. With the growth in popularity of physical fitness early last century, coupled with a growing interest in India by Europeans and Americans, Hatha was revived and further physical postures were created combining gymnastics with entertainment. This forms the basis of today’s most popular form of Yoga in the west, called modern postural yoga (Singleton, 2010), which is now influencing even India’s perception of Yoga.

The definition of yoga from the Sanskrit means “uniting, or yoking, the self to the higher self”.[4] The goal of integrating all the parts of oneself into a wholeness parallels at some level the actualization stage in Rossouw’s integrated neuropsychotherapy model (Rossouw, 2016), and further incorporates the spiritual and universal connection. The uniting capability of Yoga can be achieved by choosing from the enormous range of techniques that have been developed over centuries to suit different personality types and needs. The goal of all these techniques is to integrate the different facets of a person into a single wholeness by first taming the mind. The ability to tame the mind unfolds by developing the skill of equanimity, letting go of attachment to the outcome of one’s actions (bhagavadgita), or from yogascittavrttinirodhah (“containing the fluctuations of the mind”; YogaSutras 1.2). Citta (“the mind”) comprises all the complexities of memory, habits, behaviors and thoughts, and its fluctuations are the root cause of human unhappiness.

This has given rise to many variations within the five main paths of Yoga—Hatha, Jnana, Karma, Raja, and Bhakti. It is these variations that can provide an entry point for balance and integration appropriate for one’s own nature and inclinations:

Hatha. The physical and hence the bodily practices of Hatha Yoga, which is built on Tantra elements incorporating energy and breath work, mantras and mudras, physical postures and cleansing techniques.

Jnana. If one is inclined toward knowledge and intellect, then Jnana Yoga is appropriate.

Karma. The path of action is Karma Yoga, which stresses that the importance of doing what is right for the individual, and to not be attached to the result.

Raja. Raja Yoga has an emphasis on meditation.

Bhakti. For those who find joy in devotional practices such as kirtan, prayer, or group chanting of mantras, Bhakti Yoga is the path.

Hatha Yoga, with its physical postures and Tantra energy focus, is most associated with the word “yoga”. In today’s world, the emphasis has shifted primarily to the asanas (“postures”) stemming from the creative period at the beginning of last century as already mentioned. There are numerous popular styles of Hatha Yoga, such as Integral (merging of all Yogas including the non-Hatha Yogas), Iyengar (static, alignment emphasis), Ashtanga (energetic and repetitive), Vinyasa (flow), and Kundalini (energy based). Each has its own emphasis and variation of approach, but they are all Hatha Yoga. If you are using postures and body connections, you are doing Yoga regardless of branding.

Hatha Yoga does not only comprise physical postures. It also encompasses the Tantra sciences, offering tools to quieten the fluctuations of the mind. They are:

Prana and pranayama: specific breathing techniques to control the flow of energy and fluctuations. Some of these have migrated into psychotherapy, where breath is used as a grounding tool to bring the client back into the present and circumvent the stress response.

Dhyana and dharana: meditation and mindfulness technologies, which have migrated into psychotherapy. Taken out of the context of Yoga, these have been renamed as body rotation or body relaxation, mindfulness, visualization, or a resourcing tool.

Kundalini, chakras, and nadis: disciplines relating to energy flow.

Mantra: the use of sound and vibration for well-being. There are noteworthy parallels between a Yoga technique called bhramari pranayama, which can induce a deep mental relaxation thought to be caused by stimulation of the vagus nerve by the cranial vibrations from the sound, and the use of transcutaneous vagal nerve stimulation with electrodes for cluster headaches, epilepsy, and treatment-resistant major depression (see, e.g., Sackeim et al., 2001).

Integrating mind, body, and breath is what sets Hatha Yoga apart from exercise.

The western popularity of Pataňjali’s YogaSutras as the source for the meaning of Yoga is based on the dualist Samkhya philosophy. Pataňjali’s YogaSutras are indeed an important and profound contribution and have been extensively used in the science and psychology literature; see, for example, Kathryn Rossi’s interesting insights into neuroscience, Buddhism, and Pataňjali’s 8 Limbs of Yoga (Rossi, 2018). The Yoga Sutras are a compilation, drawn from various ancient texts and teachings available at the time, pertaining to wisdom and practical ways to quieten the mind to find union with one’s own sense of the divine. Within the much broader span of works written on Yoga over millennia, the Sutras are only one part of a much larger body of knowledge encompassing the wisdom and practices of Yoga. Regardless of their place in history—if the path resonates, then follow it, as all paths lead to the same absolute reality.

The Yoga Model of Integration

What we think and feel, the memories and behavioral patterns that have become etched into us, are all reflected in the breath and the body. We read the state of ease or unease in a friend or relative through their physical demeanor—in the way they hold their body with ease or tension. How our mental state manifests in the body is now being understood at the molecular level. The instant we feel anger, frustration, or fear, we have triggered the HPA system, which links to the sympathetic system and has a cascading effect on our whole physiology before we have even consciously registered our response. The classic fight–flight reaction to our thoughts and experiences shape our mind and our body, including changes in physiology, posture, breathing pattern, immune-system activation, proprioception, chemistry, digestion, the nervous and circulatory systems, and the musculoskeletal system. All these responses leave visible markers in our physical bearing, bodies, and appearance.

Yoga’s foundation is the knowledge that we are integrated beings. The mind affects our body and the body affects our mind. The body can become a very powerful tool when we get stuck in mind loops. Sensations, reflexes, injury, pain, physical restrictions, breathing, movement, and food all affect our mental state.

As multi-dimensional beings we have a need to integrate the different parts of ourselves in order to create a sense of the wholeness of “me”. One particular Yoga path suggests that at our center is the spark of divinity, the atman, our spiritual reality. According to the yogic view, as described by Vivekananda (2005), a person is a spiritual entity who uses the body–mind as a vehicle for interacting in the material world. The meaning of the terms divinity and spiritual are unique for each individual.

The “body–mind vehicle” can be thought of in Yoga as part of the layers, or sheaths, around this spark of divinity at our center, the number of layers varying according to a Yoga philosophy path. One commonly used model is the panchamayakoshas, the five-sheath model, illustrated in Figure 2.

The key to all the models is that the sheaths or layers are all interconnected, and any disturbance or rebalance in one layer will ripple through all the layers. For example, for people stuck within their emotional barriers, movement (anamaya kosha) and breath (accessing pranamaya kosha) can be used to create changes in the mind layer (manomaya kosha), rather than confronting these barriers head-on. For Yoga, this attention to somatic sensations in psychotherapy and other somatic interventions in therapy is based on the kosha model.

Table 1 describes the characteristics of the five koshas. Because specific koshas can be influenced by different Yoga tools, there is a large range of choices that can be tailored as appropriate to the needs of the individual.

Yoga Practices in Talking Therapies

Shifting our awareness to the physical self (such as feeling the sensations of touching a chair or the breath) changes our physiology, which ripples through to our mental state. This interconnection between mind and body has been recognized by talking therapies as a powerful tool to bring clients back into the present moment and short-circuit a fall back into the default mode.

Yoga techniques such as somatic sensation and movement, breath attention and control, and mindfulness and meditation techniques are now generally utilized in talking therapies. The integration of the mind, body, and breath in Yoga act in unison rather than as separate parts and develop the skills of interoception (the ability to feel subtle signals from the body) and proprioception (feeling our position in space). Our culture is increasingly “head-heavy”, and there is a disconnect from the body. The simplest moves for beginners in Yoga, such as placing an arm or a leg in a different position to their habitual posture, requires re-learning the skill of feeling. In psychotherapy this yogic body–awareness technique is called resourcing, that is, keeping a client in the present. Bringing attention to the contact between the body and the chair anchors the client into the present and prevents a re-living of a trauma. Pat Ogden’s use of this kind of somatic vocabulary makes use of resourcing in her sensorimotor psychotherapy approach (Ogden & Minton, 2000). Having a balance between all koshas is a key to well-being. Two other pioneers in this recognition of the role of the body in psychological disorders are Bessel van der Kolk and Peter Levine. Van der Kolk’s pioneering work in understanding the psychobiology of stress broke new ground with the concept that “the body keeps the score”, or “stores” the effects of past trauma (van der Kolk, 1994), while Levine’s somatic experiencing approach works with “completing” unresolved and incomplete physical residues left by a traumatic event (Levine & Kline, 2012).

Pranayama, or breath modulation, is used in Yoga to change a mental and physical state. The breath affects the physiology and biochemistry of the body and mind. Emphasizing long exhalations are the key to activating the PNS and dampening the SNS response to stress; this process is not merely “taking a deep breath”, as will be explained in more detail in Part 2 of this series. Breath modulation and awareness has become a standard technique in talking therapies to short-circuit anxiety, fear, and other stress responses. Mindfulness is also used, but it is not suitable for everyone, and can reactivate traumas. A dharana practice is an alternative to mindfulness and develops the skill of being able to redirect a person’s mind to where they want it to be.

Conclusion

This brief and simplified overview might provide some context to the next yoga class or mindfulness session and also insight into how the influence of Yoga on all our systems stems from its role in being able to alleviate and dampen the stress response. The inner world of the mind is a lifetime’s work in progress, but the light of Yoga can illuminate the clarity we all hold within. In the next article in this series the effect of Yoga on telomeres, epigenetics, linkages between sperm quality and childhood cancer, and brain volume changes will be explored.

Levine, P. A., & Kline, M. (2012). Use of somatic experiencing principles as a PTSD prevention tool for children and teens during the acute stress phase following an overwhelming event. In V. Ardino (Ed.), Post‐traumatic syndromes in childhood and adolescence: A handbook of research and practice (pp. 273–295). Chichester, United Kingdom: Wiley.

Whiteford, H. (2015). Updated estimates of burden due to mental and substance use disorders from the Global Burden of Disease Study 2013. Journal of Mental Health Policy and Economics, 18.

[1]1 Capitalized “Yoga” refers to Yoga in the broadest and original sense, in contrast to its subset of modern postural yoga focused on the physical asana practice that most people associate with the word (Singleton, 2010). This latter subset of Yoga is referred to as “yoga”. Both include mindfulness and meditation practices.

[2]2 A quick search of “yoga” on PubMed in November 2018 resulted in more than 4,700 publications.

Neuroscience-Based Cognitive Therapy for the Treatment of Post-Traumatic Stress Disorder: Theory, Methods and a Single-Case Research Study

Tullio Scrimali
University of Catania, Catania, Italy

Click here to download a PDF of this paper and to see all the figures.

Abstract
Neuroscience-based cognitive therapy is a new science- and evidence-based psychotherapy approach that attempts to integrate certain psychophysiological methods such as monitoring of electrodermal activity (EDA) and skin conductance biofeedback (BFB) with selected cognitive techniques to treat mental disorders. This article describes EDA as a psychophysiological parameter that can support a neurobiological model of post-traumatic stress disorder (PTSD). BFB was proposed as an additional therapeutic technique that can improve the efficacy of the cognitive therapy protocol. A single-case experimental study was undertaken, in which a patient affected by PTSD was treated for four months with BFB to augment his cognitive therapy. The results obtained after the treatment and a two-year follow-up demonstrate that neuroscience-based cognitive therapy is efficacious when used in the treatment of PTSD. The positive results demonstrate that neuroscience-based cognitive therapy is not only science-based but also evidence-based.

Neuroscience-based cognitive therapy, which was developed by Scrimali (2012), is a new, integrated approach to the treatment of mental disorders.

The aim of this fourth-wave cognitive therapy, as named by Arthur Freeman (2012), is that it is to be science-based and evidence-based, and that it is grounded in neurobiology to develop a neuroscience-based psychopathology (Scrimali, 2008). Neuroscience-based cognitive therapy also attempts to integrate certain psychophysiological methods such as monitoring of electrodermal activity (EDA) and biofeedback (BFB) with certain cognitive and behavioral techniques. The aim is to develop clinical protocols that are both science-based and evidence-based (Scrimali, Tomasello, & Sciuto, 2015).

In this article, the author describes his work applying the new paradigm of neuroscience-based cognitive therapy to better understand and treat post-traumatic stress disorder (PTSD).

A neurobiological model of the psychopathology of PTSD is first described to establish a tailored integrated treatment for PTSD that includes certain applied neuroscience techniques, such as monitoring of EDA and BFB.

EDA is a biological parameter that provides information regarding the psychological condition of an individual (Prokasy & Raskin, 1973). EDA reflects the level of functioning in the sweat glands, which is linked to the dynamic processes of the central and peripheral nervous systems (Scrimali, 2012; Scrimali et al., 2015). EDA is a very sensitive marker of any tonic (i.e., the skin conductance level; SCL) and transient (i.e., the skin conductance response; SCR) changes in arousal, which is one of the most important characteristics of PTSD (American Psychiatric Association, 2013). In neurobiological terms, EDA provides reliable information regarding activation of the amygdala and altered modulation exerted by certain frontal areas of the brain (Boucsein, 1996; LeDoux, 1996; Nagai, Cristchley, Featherstone, Trimble, & Dolan, 2004). In fact, when patients affected by PTSD are asked to imagine a threatening situation, their electrodermal responses (i.e., SCRs) have been found to be greater than those of the control subjects (Orr, Metzger, & Pitman, 2002).

According to the neurobiological perspective (Scaglione & Lockwood, 2014), PTSD is a syndrome characterized by three main clusters of symptoms, as follows:

In terms of applied neuroscience, EDA is a good marker of PTSD that can document certain biological aspects of re-experiencing and hyperarousal. When using this parameter, it is possible to document the intense physiological reactions to reminders and most hyperarousal symptoms. Clinical monitoring of EDA can therefore be useful for studying certain neurobiological aspects and symptomatology. Obviously, the outcome should also be documented according to any changes in this parameter. A demonstration of these two topics was one of the goals of the study.

From Neurobiology and Applied Psychophysiology to BFB

Using neuroscience in trauma therapy constitutes a very recent approach to the treatment of PTSD (Uhernik, 2017). BFB appears to be an ideal choice to augment the cognitive therapy used with PTSD patients undergoing treatment. Some preliminary studies integrating BFB with cognitive-behavioral therapy (CBT) to treat PTSD have shown positive results (Silver, Brooks, & Obenchain, 1995), and the use of BFB in the treatment of PTSD was scored as Level 2 (i.e., possibly efficacious) in a study by Yucha and Montgomery (2008). Despite the potentially great value of BFB in the treatment of PTSD, however, the evidence to date is insufficient regarding the efficacy of this treatment in PTSD.
Integrating BFB into psychotherapy is one of the main goals of neuroscience-based cognitive therapy. A single-case research study was therefore carried out to evaluate the efficacy of EDA monitoring and EDA–BFB in the treatment of patients affected by PTSD.

Methods

This study was conducted according to the methodological principles adopted in n = 1 case-study research (McLeod, 2010).

A 52-year-old male patient was treated for eight months with an integrated electrodermal BFB–CBT protocol.

Three months before starting the treatment, the patient had experienced a traumatic event. The patient was driving along a leafy avenue in the Sicilian town where he lived. There was a windstorm. While stopped at traffic lights, a large tree was uprooted by the violence of the tornado and fell several meters onto his car. The patient had only enough time to lie sideways across the passenger seat before the car’s roof was completely crushed. He remained in this position (with several broken ribs) for several hours until emergency personnel were able to pull the tree off the car. The car itself was destroyed.

During the following weeks he started experiencing intrusive memories of the event. In particular, he saw the tree flying toward his car and crushing it. He also experienced similar recurring dreams that woke him from his sleep. He experienced intense anxiety reactions every time he drove his car. He complained of severe reactions of anxiety every time he saw a tree or felt wind.

Unfortunately, his primary care physician did not correctly diagnose these symptoms as PTSD and criticized the patient for not being “man enough” to recover quickly from the accident. The patient then became depressed and exhibited impaired self-esteem. He also experience various symptoms associated with hyperarousal, such as hypervigilance, poor concentration, and sleep problems.

The symptoms continued for three months until the patient decided to seek help at the Applied Neuroscience and Cognitive Behavioral Therapy Unit of the ALETEIA Clinical Center in Enna, Italy, where he was diagnosed according to the criteria described in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (American Psychiatric Association, 2013).

Since a new neuroscience-based cognitive therapy protocol for PTSD had recently been developed at the Center, the patient was offered this treatment. He was informed that because this therapy was experimental, it would be provided free. The patient read and signed an informed-consent document, which is available on file at the ALETEIA Clinical Center.
The research study was conducted according to the laws and regulations of Italy and any applicable international norms and standards, primarily, the Declaration of Helsinki (World Medical Association, 2013). The study protocols were reviewed and approved by the Committee for Clinical Research at the ALETEIA Clinical Center. Funds and logistics for the research study were provided by the Istituto Superiore per le Scienze Cognitive, Enna, Italy, which is a nonprofit, private institution according to its philanthropic mission.

The patient attended weekly sessions as an outpatient at the applied neuroscience and CBT unit at the ALETEIA Clinical Center for a period of four months (a total of 16 sessions). During these sessions, the EDA and BFB trials were monitored.

Treatment was based on electrodermal BFB, which was used as an instrument for desensitization and reprocessing the trauma.

The MindLAB Set system produced by Psychotech (http://www.psychotech.it) was utilized. The hardware consisted of a pair of electrodes and an interface device for data collection and transfer to a computer. Two integrated programs, MindSCAN and Psychofeedback, were used to monitor and record the EDA (MindSCAN) during weekly BFB sessions (Psychofeedback).
At each session, the patient was asked to sit in a comfortable chaise longue. The temperature in the laboratory was monitored frequently and maintained at 22°C (winter) and 24°C (summer).

A monitor and two speakers were positioned in front of the patient to provide visual and acoustic feedback related to the SCL.

The treatment was conducted according to the original CBT protocol with a number of additional steps that integrated the electrodermal BFB with the PTSD treatment model proposed by Ehlers, Clark, Hackmann, McManus, and Fennell (2005). The developed protocol included the following steps:

psychoeducation;

auto-observation and monitoring;

learning to lower arousal according to BFB;

image exposure;

imagery re-scripting; and

cognitive restructuring.

Psychoeducation. It was explained to the patient that he was experiencing a common mental disorder rather than a “stupid habit”, as his physician previously stated. He was told that PTSD is quite frequent in individuals who have experienced a trauma similar to his. He was informed that he was not cured, but that after adequate treatment consisting of cognitive therapy, he would recover.

Auto-observation and monitoring. The patient observed through the computer monitor that his levels of arousal, as measured by monitoring the SCL, were high in comparison with the normative database. He was asked to imagine the scene of the accident, and a further increase in arousal was observed. Thus, the patient realized that his emotional and physical disturbance was provoked by a flashback of the trauma.

Modification of instructions. The patient was taught emotional self-regulation through BFB. The treatment was conducted as follows.

The patient was encouraged to lower arousal by acting at thinking, imagery, emotion, and somatic levels. He was further encouraged to establish different types of cognitive, emotional, and bodily attitudes. As the graph of the SCL was drawn on the monitor and reinforcement sounds were presented, the patient was encouraged to understand and memorize the specific set realized in that specific moment in his mind and body. Similarly, when both visual and acoustic feedback informed the patient that his arousal was increasing, he was trained to understand the type of negative attitude he was producing and avoid it.

The patient developed an understanding of a coping strategy that was useful in reducing arousal. Then he was encouraged to generalize this strategy to real-life situations. At the beginning of each session, before practicing BFB, the SCL was measured and the recorded values were discussed with the therapist. When the SCL was high (i.e., when it indicated a warning sign of stress), the patient was encouraged to identify the reason for the increased arousal and attempt to reduce the stress. The training was intuitive, comfortable, and interesting for the patient.

Image exposure. During some sessions, the patient was asked to lower arousal via BFB and imagine the scene causing his trauma.

Imagery re-scripting. While reactivating the image of the trauma, the patient was encouraged to change something about the previous script. In fact, during these sessions, the patient began to change his internal dialogue, telling himself: Really, I was smart and quick-acting when I changed my position in the car before the tree crushed it. This change increased his sense of mastery and self-esteem and improved his mood.

Cognitive restructuring. Due to the BFB training, and some sessions based on Socratic dialogues, the patient started to change certain automatic thoughts and schemas as follows:

I am stupid and weak because I am not able to overcome this problem by myself!

It was my responsibility when I decided to drive in that place during a storm!

He developed a sense of mastery and constructed a positive sense of what occurred. The new sense was as follows:

Trauma occurs, and the victim is not responsible for this!

They should be helped to recover from a disorder they developed, and this is not evidence of being weak but rather a mental disorder named PTSD.

Materials

The outcomes for the patient were evaluated by the following assessment instruments:

Impact of Event Scale (Horowitz, Wilner, & Alvarez, 1979)

Beck Anxiety Inventory (Beck, 1993)

Beck Depression Inventory (Beck, 1996)

SCL registered by MindLAB Set (Scrimali, 2012).

Results

To create a time-series analysis, three sets of data were collected every week for all measures at the following time points: baseline, end of treatment, and follow-up after two years. The data are reported in Tables 1, 2, 3. and 4, and illustrated in the graphs in Figures 1, 2, 3, and 4

A statistical analysis of the data reported in the tables and graphs was carried out, using the time-series simulation modeling analysis developed by Borckardt et al. (2007).

The three values of the baseline, which were collected each week before starting the treatment, and the six values collected at the end of the treatment, and at a two-year follow-up, were compared. All four series of data exhibited a significant improvement that was maintained after two years.

The EDA values at the beginning and end of the treatment were also compared using the Student’s t-test. This analysis was carried out automatically by the MindSCAN software. The difference was significant (p < 0.05); see Figure 5.

Discussion

The project integrating applied neuroscience and BFB into a CBT protocol for the treatment of PTSD has been positive. The following goals were achieved:
Lowering basic arousal without using any drug treatment.

Lowering and maintaining low arousal during traumatic image exposure.

The setting in which the CBT was augmented by the BFB was comfortable for both the patient and the therapist.

Re-scripting the scene of the trauma created a sense of safety and calmed the patient, and the patient developed mastery due to the practice of BFB.

The cognitive restructuring, imagery, acceptance of the trauma, and narrative re-scripting were successful and enhanced the sense of mastery and self-control learned by the patient during the BFB sessions.

The results were very stable as demonstrated by the two-year follow-up analysis.

Conclusion

This research study has demonstrated that integrating applied neuroscience and BFB into cognitive therapy to treat PTSD is realistic and useful. The study has also confirmed that neuroscience-based cognitive therapy can be successfully applied to patients afflicted by PTSD.

Lowering arousal by improving cortical frontal activity in the brain and lowering the amygdala response can be achieved using both cognitive therapy and applying BFB.
Figure 5, which represents the changes in the EDA (spontaneous phasic activity and tonic activity), demonstrates that some evident neurobiological change occurred in the brain of the patient due to the treatment.

The robust design of this research study, which was carried out according to the guidelines of a single-case research study, and the clear results provide supporting evidence for the protocol.

The protocol, including the MindLAB Set, is inexpensive and easy to apply without any specific training is an added advantage.

In conclusion, the results of this study support neuroscience-based cognitive therapy as a new and useful approach to understanding and treating PTSD. The protocol is both neuroscience- and evidence-based.

Bruce Ecker

Abstract

After 20 years of laboratory study of memory reconsolidation, the translation of research findings into clinical application has recently been the topic of a rapidly growing number of review articles. The present article identifies previously unrecognized possibilities for effective clinical translation by examining research findings from the experience-oriented viewpoint of the clinician. It is well established that destabilization of a target learning and its erasure (robust functional disappearance) by behavioral updating are experience-driven processes. By interpreting the research in terms of internal experiences required by the brain, rather than in terms of external laboratory procedures, a clinical methodology of updating and erasure unambiguously emerges, with promising properties: It is applicable for any symptom generated by emotional learning and memory, it is readily adapted to the unique target material of each therapy client, and it has extensive corroboration in existing clinical literature, including cessation of a wide range of symptoms and verification of erasure using the same markers relied upon by laboratory researchers. Two case vignettes illustrate clinical implementation and show erasure of lifelong, complex, intense emotional learnings and full, lasting cessation of major long-term symptoms. The experience-oriented framework also provides a new interpretation of the laboratory erasure procedure known as post-retrieval extinction, indicating limited clinical applicability and explaining for the first time why, even with reversal of the protocol (post-extinction retrieval), reconsolidation and erasure still occur. Also discussed are significant ramifications for the clinical field’s “corrective experiences” paradigm, for psychotherapy integration, and for establishing that specific factors can produce extreme therapeutic effectiveness.

1. Introduction
A primary dilemma in clinical psychology has been described by one of that field’s leading voices in this way: “After decades of psychotherapy research, we cannot provide an evidence-based explanation for how or why even our most well studied interventions produce change, that is, the mechanism(s) through which treatments operate” (Kazdin, 2007, p. 1). The present article proposes that a fundamental breakthrough in that dilemma may be developing through the translation of memory reconsolidation neuroscience into clinical application.

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Memory research has identified an innate type of neuroplasticity in the brain, known as memory reconsolidation, that can destabilize the neural encoding of learnings of many types, including emotional learnings. Destabilization in turn allows the target learning to be nullified either endogenously, by behavioral counter-learning, or exogenously, by pharmacological blockade that disrupts the natural molecular and cellular process of restabilization, or reconsolidation, that normally would occur after several hours (Duvarci and Nader, 2004; Pedreira et al., 2002; Pedreira and Maldonado, 2003; Walker et al., 2003). Thus nullified, the subsequent durable, robust disappearance of all expressions of the target learning has been termed its erasure by many researchers (e.g., Kindt et al., 2009; for reviews see, e.g., Agren, 2014; Nader, 2015; Reichelt and Lee, 2013; Schwabe et al., 2014; for a review of early, anomalous observations of erasure prior to discovery of reconsolidation, see Riccio et al., 2006). By putting the transformational change of memory on empirical solid ground, research on memory reconsolidation has paved the way for new common ground between neuroscientists and clinicians, who have filed fine-grained anecdotal reports of such transformational change for decades (e.g., Ecker and Hulley, 1996, 2000a, 2008; Fosha, 2000; Greenberg et al., 1993; Shapiro, 2001).

Memory reconsolidation is a neurological process that is experience-driven: behavioral and perceptual events trigger it into occurring and can govern the resulting effects on the target learning. The relevance of reconsolidation research findings to psychotherapy is potentially very great because clinical symptoms are maintained by emotional learnings held in implicit memory, outside of conscious, explicit awareness, in a wide range of cases, including most instances of insecure attachment, post-traumatic symptomology, compulsive behavior, addiction, depression, anxiety, low self-esteem, and perfectionism, among many other symptoms (e.g., Greenberg 2012; Schore, 2003; Toomey and Ecker, 2007; Van der Kolk, 1994). A versatile, reconsolidation-based clinical methodology that targets and reliably nullifies the specific emotional learnings maintaining such symptoms would revolutionize the field of psychotherapy. Envisioning that new landscape, neuroscientists Clem and Schiller (2016, p. 340) wrote, “To achieve greatest efficacy, therapies…should preclude the re-emergence of emotional responses.” Defining complete elimination of unwanted emotional responses as the goal of psychotherapy is a statement that no neuroscientist would have ventured to make prior to 2000, before the discovery of memory reconsolidation. It is a goal now recognized as a possibility grounded in empirical research. That goal is the operational definition of erasure in this article: lasting, effortless, complete cessation, under all circumstances, of an unwanted behavior, state of mind, and/or somatic disturbance that had occurred either continuously or in response to certain contexts or cues.

Currently, at the end of the second decade of laboratory research into reconsolidation, researchers’ attention is extending to considerations of clinical translation at a rapidly accelerating pace (e.g., Beckers and Kindt, 2017; Dunbar and Taylor, 2016; Elsey and Kindt, 2017a; Krawczyk et al., 2017; Kroes et al., 2015; Lee et al., 2017; Nader et al., 2014; Treanor et al., 2017). Those authors have consistently called for a two-way flow of knowledge between researchers and clinicians in order to achieve the fullest clinical utilization of memory reconsolidation. Nader et al. (2014, p. 475) wrote:

We feel that ongoing discourse between mental health clinicians and neuroscientists is beneficial both for scientific progress in neuroscience and mental health treatments. Neuroscientists may benefit from being educated about clinical models of mental disorders…. The reductionist approach intrinsic to scientific activity forces neuroscientists to simplify their models in the pursuit of scientific questions considered to be of a fundamental nature. Unavoidably, at times, this approach may ignore some aspects of mental disorders. A discourse with clinicians allows neuroscientists to realign their models to ensure that they represent processes thought to cause or maintain these disorders.

Similarly, researchers Elsey and Kindt (2017a) opined that “Dialogue between researchers and clinicians must be maintained” (p. 114) and, in concluding an extensive review of the prospects for effective clinical application of reconsolidation research findings, commented, “there are significant limitations to experimental research, and ultimately only attempts at treatment can reveal the utility of a reconsolidation-based approach” (p. 115).

Those comments serve to define the purpose of the present article, which is a report from the clinical trenches of observations made in the course of directly applying the empirically identified, endogenous process of memory erasure. This article describes what appear to be encouraging advances. The author, a psychotherapist and former research physicist, has since 2005 maintained close scrutiny of reconsolidation research while also closely observing the effects in therapy sessions of processes designed to translate memory reconsolidation research into clinical application.

Members of the clinical domain have been enthusiastically consuming and working to utilize the knowledge being generated by laboratory neuroscience researchers since the 1990s (e.g., Siegel, 1999; van der Kolk, 1994). There has been little to indicate a flow of knowledge in the other direction, however. Undoubtedly there is more than one reason for that asymmetry, which is particularly acute at present as regards reconsolidation. There is now a substantial clinical literature that documents observations ascribed to reconsolidation and that delineates clinical methodologies demonstrating translation of reconsolidation research (e.g., Ecker, 2008, 2010, 2015a,b, 2016; Ecker and Hulley, 2008, 2017; Ecker and Toomey, 2008; Ecker et al., 2012, 2013a,b; Högberg et al., 2011; Lasser and Greenwald, 2015; Sibson and Ticic, 2014; Soeter and Kindt, 2015a; Ticic and Kushner, 2015). Rarely, however, is such literature cited in the writings of laboratory researchers, who regularly express anticipation of and need for advances already made by clinicians. Examples of that are myriad; the two most recent instances encountered by the author are these: Krawczyk et al. (2017, p. 16) commented that “outside the laboratory settings such as in clinical ones, it is unclear how the reconsolidation process might work.” Elsey and Kindt (2017a, p. 114) commented that laboratory research has focused largely on fear learnings and that “experiences of other emotions, such as disgust…or of more complex feelings such as guilt and shame after reconsolidation-based procedures are essentially untapped.” In fact, numerous clinicians’ reports have documented in a fine-grained manner how a wide range of complex emotions and emotional learnings have been subjected to the empirically confirmed reconsolidation process of behavioral erasure (see citations above in this paragraph; for online listings of relevant clinical reports, see http://bit.ly/2tKXdyX and http://bit.ly/15Z00HQ). Section 7 of this article provides samples of such clinical work and its documentation.

The rigor of the clinical observations reported here is of a different type from that of the quantitative measurements made in laboratory controlled studies by neuroscientists. Here the aim is phenomenological rigor that capitalizes on the unique ability of human subjects (therapy clients) to direct attention to their own mental and emotional states and to describe the moment-to-moment effects as the steps of the destabilization and erasure process are carried out. Neuroscientists have barely begun to utilize such articulation of subjective experience for gaining access to the memory reconsolidation process, but even their first forays in that direction were very fruitful (Sevenster et al., 2013, 2014). The clinical case studies documented in this article are intended to show that examining the raw data of therapy clients’ real-time phenomenological reports can significantly help advance the clinical translation of memory reconsolidation research (see also Heatherington et al., 2012).

The clinical work reported here is intended to demonstrate the application of reconsolidation research, so an examination of relevant research and its translational implications precedes the clinical material detailed in Section 7. As noted, reconsolidation has been demonstrated and studied for many different types of memory, but the research covered here is limited to how the process applies to emotional learning and emotional memory, as they play by far the principal role in psychotherapy. (See reviews cited above for the full range of research.) The cellular and molecular levels of reconsolidation research are also not covered here. Clinicians need not attend to the highly complex neurophysiological and neurochemical substrates of destabilization and erasure (for a review of which, see Clem and Schiller, 2016). However, clinicians should understand that robust functional erasure does not necessarily correspond to total loss or ablation of the entire neural encoding of the erased responses and learnings, according to recent findings (Ryan et al., 2015), and any simplistic image of what happens to neural circuits when erasure is achieved is almost certain to be significantly incorrect.

Lastly, regarding this article’s usage of an emotional “learning”: A terminology bridge between neuroscientists and clinicians is much needed. Memory researchers as a rule refer to a learned item of any type as a “memory,” not as a “learning”; they refer to the “target memory” rather than the “target learning.” If the learned item in question is, for example, implicit knowledge that would be verbalized as “If I express myself I’ll be criticized and rejected,” researchers would refer to that as the “memory” under study. That usage of “memory,” while perfectly clear to memory researchers, is likely (in the author’s experience) to create considerable confusion for clinicians, who would tend to understand “memory” as referring to the person’s episodic memory and/or declarative memory of the original childhood events involving rejection, rather than the semantic memory consisting of a generalized model and expectation of people being active rejecters. In order to avoid that confusion for clinician readers (this article being intended for both memory researchers and clinicians), the text here refers to an “emotional learning.” That syntax is identical to how “understanding” may be used as in “it resulted in the understanding that….”

The following paper will discuss the dynamics of structured image framework theory (SIFT) and how the model directly corresponds to known brain structures. SIFT allows clients to understand both how they process everyday emotions and heightened emotional distress and how that emotional distress corresponds to and mirrors recent neurological understanding of how the brain operates. The SIFT model has been developed from thousands of client descriptions of clinical treatment over the past 25 years—from childhood dynamics, a variety of psychopathologies, community settings, and disasters through to war-service adjustment. SIFT enables the client and the therapist to use a structure that can be flexibly applied to a variety of emotionally distressing processes. The SIFT base model enables the therapist to clearly describe brain structures and functions that correspond to an applied diagram. The SIFT diagrammatic structure highlights what clients have experienced during typical or difficult emotional processing situations. This encourages normalization, initiates adaptive processing mechanisms, and secures a stronger therapeutic alliance in a timely fashion, which increases positive therapeutic outcomes.

This paper presents the broad structures of a therapeutic framework that describes the dynamics of emotional processing. The resulting therapeutic guidelines and descriptions of the structured image framework theory (SIFT) model have been tested and formulated from a wide range of therapeutic interventions across multiple dimensions of emotional experience reported by clients over 25 years of psychological treatment.

To understand how a person processes various emotionally distressing experiences and how exposure to such experiences can affect a person’s day-to-day functioning is a complex challenge. This understanding can be achieved by various therapeutic techniques that aim to reassure the client with a sense of personal safety and control. The better clients can understand how they have been emotionally impacted from an experience and how they can expect to adjust through predictable processing systems, the better they can develop, grow and adapt to their environment.

As has been shown within the field of psychotherapy, it is vital to promote an expectation that a client can change their emotional discomfort and potentially developed psychopathology to a more positive adaptive thriving state (Prochaska, 1984). Therapy should promote positive change. The SIFT model encourages the client to have conscious experiential feedback through cathartic corrective emotional experiences, self-liberation, counter-conditioning, and re-evaluation processes (Prochaska, 1984).

Neuropsychotherapy emphasizes aspects of how the brain’s functions can be shown to foster change and healing through therapy. Under the therapist’s guidance, neuropsychotherapy should emphasize how the client’s own brain is processing information. Ideally, therapy should promote the power of a person’s own brain and facilitate its capacity to take over and thrive from a stuck point in processing following a significant emotional impact (Shapiro, 2012). The principles of how the brain can change itself through significant emotional experiences are vital for promoting individual growth. The fact that neuroplasticity reveals how our brains are self-changing, and that they develop structures unique to the individual and continue to change throughout our lives, gives the therapist and client great hope. Unfortunately, neuroplasticity not only makes our brain more resourceful but also more malleable to outside environmental influences that can lead to maladaptive psychopathology if not guided effectively by the support of others (Doidge, 2007).

The difficulty of encouraging the therapist to have a greater capacity to navigate and moderate a client’s emotional distress within felt controlled parameters during treatment remains the challenge. A better understanding of how the brain functions in times of emotional distress can improve the capacity of the therapist and client to control emotional disturbance and promote healthy personal growth (Rossouw, 2014).

As with any sound theoretical framework (Hjelle & Ziegler, 1992), SIFT explains how a person experiencing multiple emotionally disturbing situations can potentially develop maladaptive adjustment. SIFT works within clear and explicitly defined concepts that can logically generate testable predictions for both therapist and client: It enables the therapist to explore a variety of distressing experiences that can cause negative pain cycles, catastrophic thought patterns, anxiety, post-traumatic stress disorder, complicated grief, depression, inconsistent performance, and reduced resilience to cope with adversity in their clients. The SIFT diagrammatic structure illustrates how a broad range of emotional experiences can affect the client. SIFT does this in an internally consistent manner and also encompasses a diverse range of behavioral shifts that may be associated with distress throughout life (Hjelle & Ziegler, 1992).

An important aim of the model is to show how the challenges we face can be represented to the client so that he/she understands how emotionally distressing information is typically processed. SIFT has been formulated to increase the ways in which a client can understand the dynamics involved in everyday emotional processing and potentially in the development of non-adaptive psychopathology disorders. The SIFT model has been designed primarily to enable the counselling clinician to facilitate long-term recovery and promote positive personal growth in a client who is having trouble adjusting to life’s challenges (Bouda & Diver, 2012).

Van der Kolk’s (1994) schematic representation of the effects of emotional arousal on declarative memory showed how explanatory models can give the client and clinician a greater applied understanding of trauma processing. Therefore, it is preferable that an applied model should be concise, clear, and flexible. The SIFT model enables a client after suffering trauma to understand their current psychological state and encourage proactive self-management strategies in the future.
One of the fundamental factors for someone experiencing psychological distress during a forced time of adaptation is an overwhelming sense of personal loss of control. As Pieter Rossouw (2014) made clear in his integrated model of neuropsychotherapy, a sense of personal safety with enriched environmental triggers promotes a greater capacity to approach higher order constructs and better attachment to others, which in turn develops a greater sense of self. If, on the other hand, there are compromised environmental triggers, these factors can be hampered or promote avoidance and feelings of being unsafe (Rossouw, 2014). If safety is compromised within the clinical treatment session, it can be detrimental to use a bottom-up/top-down therapeutic approach with a client who lacks a full understanding of how they arrived at their heightened emotional state. This is where SIFT is invaluable in enabling a person to understand how environmental stimuli and activated memories are processed in a framework that mirrors multiple dynamics of brain function during treatment (Wilson, 2014).

The following developed SIFT model (Figure 1) enables clinicians and their clients to understand the processes that are involved in adapting to everyday emotional processing as well as complex and overwhelming environmental stimuli that are within or beyond a person’s current adaptive capabilities.

The Base Theoretical Elements of the SIFT Model That Correspond With Brain Function

Initial storage area (ISA)—the ISA filter. As shown in Figure 1, the ISA filter represents to the client the access point where environmental information from all senses is initially processed according to a person’s established belief structures. The Î’s across the filter structure in Figure 1 represent the linkage between the Î’s in the central part of the emotional processing area (EPA) and the connecting lines of the established belief structures, which access the long-term storage area (LTSA).

The ISA filter shows how, if a person wants to accept information because they are familiar with the presenting information, or have enriched environmental triggers or stimuli (Rossouw, 2014), he or she will accept emotionally based information into the ISA structure. If, however, the ISA filter finds the environmental information irrelevant or compromising to the client’s world view (i.e., a summary of one’s individually developed belief structures), the client will either reject, or ignore, or not notice the information presented for everyday emotional processing. If danger or life threat is perceived, the ISA filter will shut down and endangering environmental stimuli will rapidly be absorbed into the ISA.

Initial storage area (ISA). As shown in Figure 1, everyday emotionally based stimuli are processed through the ISA filter, which influences what is accepted into or rejected by the ISA. Once stimuli are accepted as important by a person’s individual belief system filter, they are processed beyond this area for immediate day-to-day functioning or rehearsal for future use in the LTSA.

This immediate day-to-day functioning and information rehearsal allows labelling of the accepted emotional content by the emotional labelling points (depicted by Î’s in the ISA filter and EPA) to be processed into the LTSA. This process also allows the emotionally based environmental stimuli to be labelled in a positive or negative emotional orientation, according to an individual’s previously reinforced personal belief structures. The established belief structures are individually and uniquely developed from a person’s ongoing experiences and long-term understanding of their internally perceived world view from memories held in the LTSA.

Emotional processing area (EPA). The EPA is situated between the ISA and the LTSA structures. The primary function of this area is to label and encode incoming environmental stimuli and recalled memories according to a person’s previously established belief structures. It also facilitates immediate emotional responses and enables rehearsal to take place. This emotional content rehearsal allows the individual to continuously update and modify their already personally held belief structures.

Because the EPA is a temporary and central processing area between ISA and the LTSA structures, it is vital for the client to understand this area within the theoretical understanding of the SIFT model. As Figure 1 shows, this area is linked to actioning established belief structure threads that enable new stimuli and existing memories to be encoded or modified according to a person’s previous experience base before they are used in day-to-day functioning. The SIFT model also describes how, once environmental stimuli have been accepted through the belief structure filter into the ISA, the selected stimuli are emotionally labelled via the EPA and immediately used in day-to-day functioning. The EPA emotional labelling points (illustrated by Î’s in the belief structure filter and EPA) are held in place by formed, developed, individually established belief structure threads emanating from learned experiences and memories held in the LTSA.

Long-term storage area (LTSA). The SIFT model also describes how the EPA confirms recalled memories from the LTSA when called upon for day-to-day cognitive and behavioral functioning. The emotional labelling points (depicted by Î’s draw from an individual’s previously established belief systems to confirm recalled positive or negative long-term memories. Without this confirming process, new emotional experiences cannot be influenced by already established personal belief constructs. The process allows recalled associated (reinforcing or denying) memories to be continuously reinforced or modified according to new emotional experiences and currently held personal belief structures.

The client’s established belief structures are developed through ongoing environmental stimuli, being reinforced, rewarded or negatively highlighted and encoded through long- term emotional processes over many years of development. Figure 1 shows how, once environmental stimuli/information have been influenced or encoded by the central emotional processing (which is connected to a person’s established belief structures), they think, behave and function in an individually developed and unique way. A person’s day-to-day functioning is individually modified in a positively or negatively orientated way according to their uniquely developed and established belief structures.

In summary, the SIFT’s theoretical framework aims to describe how everyday emotional stimuli and memories are processed at a subconscious level for day-to-day functioning via the central structure of the EPA. The advantage of SIFT is that a client can have a therapeutic and neurological theoretical framework that expansively describes the dynamics of emotional processing. SIFT also enables therapy to highlight how established belief structures develop in a stable, predictable, and organized fashion.

The SIFT model has multiple developed structures that can best describe how a client experiences an emotional event. It is designed as an inclusive model that allows the clinician to work within a variety of short- and long-term clinically appropriate interventions to promote the best therapeutic outcomes for the client. SIFT facilitates ways that, over time, will enable a child, adolescent, or adult in a nurturing and supportive environment to develop positively oriented long-term memory structures that promote approaching and learning from their life experiences. Alternatively, individuals who are exposed to threatening or restricted, isolating or withdrawn environments may develop negatively oriented memory structures that promote avoidant, withdrawn, and protective behavioral patterns (Rossouw, 2014).

The Brain Structures That Correspond With the SIFT Base Model

The following diagram (Figure 2) illustrates the structures of the brain that correspond to the SIFT base model according to neuroscience and how everyday emotional experiences, significant life events, and devastating life-threatening trauma are processed (Arden & Linford, 2009; Carter, 2009).

Figure 2. Brain structures that correspond to the SIFT base model.

Thalamus. SIFT’s belief structure filter (i.e., the thalamus) interacts with and has several actions that correspond to the SIFT base model, as shown in Figure 3. The following highlights how the thalamus is involved in gathering environmental information and relaying stimuli to multiple brain structures.

Brain Structures That Correspond With Belief Structure Filter

The thalamus has been described as the “relay station” for incoming information from the outside world to the cerebral cortex; it regulates brain-wave activity (plays a role in sleep and appetite) and is the starting point for all activity triggered by an external stimulus (Arden & Linford, 2009; Carter, 2009).

Seeing: Light-sensitive retinal cells fire and send signals along their axons, which are bundled together to form the optic nerve. The nerve crosses at the optic chiasm where the nerve fibres connect with a specialised part of the thalamus.

Hearing: Nerve impulses are received and processed by specialised neurons in the medial geniculate nucleus of the thalamus. These signals are then sent to the primary auditory cortex, which also feeds information back to the thalamus. Sound enters the ears and travels via the brainstem and thalamus to the auditory cortex. Here sound is processed by associated areas, such as Wernicke’s area, which is involved with interpreting speech.

Touch: From the spinal cord the signal travels through the brain stem, crossing over to the other side of the brain. Here, the nerve fibre connects with a third-order neuron in the thalamus where the signal is relayed to the somatosensory cortex to be processed. Nuclei in the dorsal spinal column and thalamus also process sensory impulses en route.

Taste: Taste and smell are both chemical senses. Receptors in the nose and mouth bind to incoming molecules, generating electrical signals to send to the brain. Both sets of signals pass along the cranial nerves. The pathway of taste related data travels from the mouth along branches of the trigeminal and glossopharyngeal nerves of the medulla, continues to the thalamus, then to primary gustatory areas of the cerebral cortex.

Note: Taste has a survival value, like smell, which allows animals to evaluate and recognise what we can potentially eat or drink. It appears the more poisonous substances tend to taste bad (bitter), while those substances that are nourishing taste pleasurable or pleasant (sweet or savoury).

Smell: Only has a combined amplifying role via the thalamus to enhance the processing of taste. Signals from olfactory bulbs pass along the olfactory tract to the olfactory cortex. The olfactory cortex processes signals from the olfactory bulb and relays them to the orbitofrontal cortex and the amygdala (if odour indicates danger/life threat or emotional fear).

Entorhinal cortex. SIFT’s ISA structure (i.e., the entorhinal cortex) shows where initial environmental information is temporarily stored and prepared for further processing that leads into the central emotional processing area. The ISA allows environmental stimuli from all senses to be primed or pre-processed for further encoding, reinforcement, and action according to a person’s understanding of the world via their established belief structures.

Brain Structures That Correspond With the ISA

The entorhinal cortex plays a major role in memory formation. Two major connections from the lateral and medial areas provide the main input to the hippocampus. They are important to pre-processing memorable information.

The lateral input stream is thought to convey spatial information to the hippocampus, while the medial input stream conveys nonspatial information. The stream of information from the entorhinal cortex through the dentate gyrus to the hippocampus is called the perforant path (Deshmukh & Knierim, 2011). It is associated with declarative and spatial memory and self-localization. A study by Shaw et al. (2007) found that in children with an increased genetic risk of developing Alzheimer’s disease, the entorhinal cortex was significantly thinner. Neuroimaging studies show that the entorhinal cortex is one of the first areas of the brain to have substantial shrinkage in patients with very mild symptoms of Alzheimer’s disease (Fischl et al, 2009).

The hippocampus enables central emotional processing for immediate thinking as well as encoding for long-term memory formation and establishing belief structure development, which feeds back and influences future emotional processing. The hypothalamus is shown to surround and influence the amygdala if danger is sensed or identified at the belief structure filter.

Brain Structures That Correspond With the EPA

The hippocampus is responsible for short-term memory and relays information to the left prefrontal cortex; it is also responsible for long-term memory storage and processing during REM sleep. Insignificant details are discarded during sleep and the hippocampus clears details for the new day after sleep. If sleep is hampered or interfered with, changes in the stress-relieving process of discarding benign details can form short-term memory thought loops (OCD/anxiety/catastrophised thinking). The hippocampus also maps events, develops context, and associates fear with environmental stimuli (Champagne et al, 2008; Frodl, 2004; Gold et al., 2010)

The amygdala collects all sensory data via the thalamus (except olfactory), has a major role in the brain’s early-warning system, is constantly aware of changes in the external environment, including possible danger (Berretta, 2005; Phan, Fitzgerald, Nathan, & Tancer, 2006).

Cingulate gyrus, dentate gyrus, middle and inferior temporal gyri, basal ganglia, subiculum—perirhinal cortex and prefrontal cortex. Figure 4 shows how these brain structures are involved in bottom-up and top-down thinking processes, action, and behavior. It also illustrates how day-to-day interaction and functioning encourages long-term memory formation. The rehearsal and consolidation process of emotional information towards higher executive functioning, use of imagery and symbolic encoding form memories into the LTSA. It shows how SIFT corresponds with the emotional processing, encoding, and long-term storage of information that promotes the establishment of individually based belief structures for future encoding, action, and interpretation of our world.

The cingulate gyrus helps regulate emotions and pain. It is thought to directly drive the body’s conscious response to unpleasant experiences. It is involved in fear and the prediction (avoidance) of negative consequences, which helps orient the body away from negative stimuli. Learning to avoid and protect from negative consequences is an important feature of memory. The cingulate gyrus has been associated with pain processing, emotion memory, and self-regulation (Carter, 2009).

The dentate gyrus is connected to the hippocampal formation, which has three highly interconnected regions: the dentate gyrus, CA3, and CA1. The dentate gyrus is one of the very few regions of the brain where adult neurogenesis (development of new neurons) has been found. It is known to play an important role translating complex codes from cortical areas into simpler codes that can be used by the hippocampus to form new memories (Carter, 2009).

The dentate gyrus has been associated with memory formation and having a role in memory recall. Improved neurodevelopment in children has been associated with exercise during pregnancy (Clapp, 1996).

The middle and inferior temporal gyri are involved in a number of cognitive processes, including semantic memory processing, language processes (middle), visual perception (inferior) and the integration of information from different senses. These structures have been implicated in recognizing and interpreting information about faces. They are part of the ventral visual pathway, which identifies “what” things are. The inferior participates in some forms of mental imagery (Schaeffer, Novaes, da Silva, Skaf, & Mendes-Neto, 2009).

Summary

Overall, SIFT describes an emotional information processing framework that is both flexible and understandable by a client. SIFT has been developed to be dynamic in order to allow a client to understand the dynamics of various stages of emotional impact, pain, or traumatic processing according to neuroscience. The SIFT model can easily condense or expand its function during unpredictable therapeutic processes throughout psychological recovery.

SIFT allows the clinician to best understand and describe to the client how initially selected environmental information is prepared and stored for further emotional processing in a more central subconscious structure, which facilitates immediate, reinforcing, motivationally rewarding and encoding systems for long-term memory structures.
The SIFT base model has several structures that show how sensory information is emotionally processed, allowing the clinician to describe a range of emotional experiences—from what a person typically experiences during everyday emotional functioning through to the extremes of life-threatening traumatic events. With this model, the clinician can highlight how a client filters and rejects or accepts environmental information using all their senses simultaneously to best navigate and adjust to their world.

In summary, Figures 1, 3, and 4 describe how the ISA filter (thalamus) relays information from sensory inputs into the ISA (entorhinal cortex), then on to the EPA (thalamus interaction, hippocampus, hypothalamus—if necessary in danger—and amygdala) and eventually into the LTSA (via processing of the cingulate gyrus, dentate gyrus, middle and inferior temporal gyri, basal ganglia, subiculum, perirhinal cortex, and prefrontal cortex). In turn, the ISA filter enables external environmental stimuli via the senses and the internal interplay of memories, knowledge, expectations, and experiences that form the basis of a person’s individual established belief structures.

Conclusion

SIFT has been conceptually designed so that the counselling clinician can facilitate long-term shifts in a client’s interpreted environment and stored memories to promote positive behavioral growth. SIFT enables clinician and client to understand the processes involved in adapting to everything, from everyday emotional processing to highly distressing incidents that are complex, overwhelming, and disorganized in nature. The strength of SIFT is that it effectively corresponds with known functions of how the brain operates. This correspondence provides a sound scientific basis for facilitating, challenging, and approaching difficult psychopathology, and in turn, promoting greater adaptive positive development to combat future adversity.

The SIFT model aims to describe how information is filtered, evaluated, and organized for emotional processing from established personal beliefs for future storage. It is anticipated that future research and publications will provide specific detail as to how SIFT can expand to illustrate to a client how traumatic exposure and pain radically alter the operation of the SIFT model due to the potentially life-threatening emotional impact and forced personal belief structure shifts that occur when surviving. In addition, the SIFT model allows a person who is severely traumatized and suffering pain to understand how they can re-establish day-to-day functioning. This in turn can enable long-term emotional processing, challenge unpredictable triggering, and promote stable, adaptive growth.

This paper has aimed to introduce an inclusive neuropsychotherapeutic construct to facilitate better treatment outcomes for clients attempting to recover. SIFT enables both the client and their therapist to understand emotional disturbance processing, using whatever therapeutic orientation they choose, while being able to effectively describe how the brain operates under duress. The SIFT model is designed to enable the clinician to work within short- and long-term interventions that can highlight the impressive dynamics of how the brain functions. Overall, SIFT has a simple, clear, and expansive conceptual framework so individuals at different stages of emotional processing can understand and explore how they are currently progressing toward long-term recovery.